Uncrossable and undilatable lesions—A practical approach to optimizing outcomes in PCI

Conor McQuillan, Matthew W.P. Jackson, Emmanouil S. Brilakis, Mohaned Egred

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


Uncrossable lesions are those that cannot be crossed with a balloon after successful guidewire crossing. These lesions are challenging and are commonly encountered in tortuous and calcified arteries as well as chronic total occlusions. They are the second most common barrier to successful PCI in CTO intervention after inability to cross the CTO segment with a guidewire. Procedures involving balloon uncrossable lesions during routine and CTO PCI utilise longer procedural times, radiation dose and contrast volumes with a lower likelihood of procedural success. In this article, we describe a pragmatic approach of managing balloon uncrossable lesions utilising the most contemporary equipment available in an algorithmic fashion beginning with simple, cost effective techniques right up to complex strategies for advanced operators. In addition, some of these lesions, even when crossed by any technique, they may remain difficult to dilate and prepare for stent insertion. We describe an approach of how to manage these undilatable lesions.

Original languageEnglish (US)
Pages (from-to)121-126
Number of pages6
JournalCatheterization and Cardiovascular Interventions
Issue number1
StatePublished - Jan 1 2021
Externally publishedYes


  • Resistant lesions
  • atherectomy, directional/rotational
  • complex PCI
  • coronary artery disease
  • laser
  • percutaneous coronary intervention
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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